Active NPI
Kelvin Roberto Ortiz Gutierrez, 714-PA
- Physician Assistant
- Bayamon, PR
National Provider Identifier
1245043504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 714-PA
- Practice address
- Ave. Betances
JK-14
Bayamon, PR 00959 - Phone
- (787) 778-5353
- Fax
- (787) 778-5353
- NPI assigned
- Jan 30, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 714-PA | PR | Primary |
Addresses
Primary practice location
Ave. Betances
JK-14
Bayamon, PR 00959
Mailing address
Urb. Jardines de Country Club
C-14 Calle 9
Carolina, PR 00983
Phone (787) 224-8858
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 714-PA | PR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738195200000",
"number": "1245043504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "URB. JARDINES DE COUNTRY CLUB",
"address_2": "C-14 CALLE 9",
"city": "CAROLINA",
"state": "PR",
"postal_code": "00983",
"telephone_number": "787-224-8858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "AVE. BETANCES",
"address_2": "JK-14",
"city": "BAYAMON",
"state": "PR",
"postal_code": "00959",
"telephone_number": "787-778-5353",
"fax_number": "787-778-5353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ GUTIERREZ",
"first_name": "KELVIN",
"middle_name": "ROBERTO",
"credential": "714-PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-30",
"last_updated": "2025-01-30",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PR",
"license": "714-PA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayamon, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.